Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
This report estimates subtotals of units and fees for the number of days of overlap between each included
FSPSA record and the user-selected report period. For example, if the FSPSA record authorizes services from
01/01/01 to 08/01/01, and the Report Period is selected as 01/01/01 to 03/01/01, this summary calculates
authorized units/fees for the 28 days of overlap (02/01/01 to 03/01/01). Note that service authorization periods
may range from 1 to 12 months and may vary in intensity from child to child.
FSPSAs overlapping: 10-01-11 and 12-31-11 Date of Report: 02-15-12 Page: 1
Eligibility Filter: Program Patients
Services Cpt Code Number of Number of Total Units Total Fees Avg Fee
Children Records Overlapping Overlapping Per Unit Auth
Report Period Report Period
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 34 34 39.000000 $1891.5000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $39.0800 $39.0800
AUDE -AUDE UNSPECIFIED AUDE SERVICES 17 18 34.352381 $2061.1500 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 7 9.000000 $405.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 12 14 18.144445 $2086.6200 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 3 3 5.000000 $625.0000 $125.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 27 29 57.000000 $7125.0000 $125.0000
EXIT -EXIT TRANSITION ASSESSMENT 193 202 398.750000 $19937.5000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 25 25 50.000000 $3750.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 20 21 42.000000 $3150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 25 25 50.000000 $2775.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 196 196 392.500000 $29437.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 72 72 144.000000 $10800.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 183 183 366.000000 $20313.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 224 247 494.500000 $37087.5000 $75.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 8 8 8.000000 $388.0000 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 3 3 3.000000 $145.5000 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 16 16 16.000000 $776.0000 $48.5000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 4 5.044444 $75.6700 $15.0000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 32 33 65.285715 $3166.3600 $48.5000
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Subtotal (Total Children Is Unduplicated) 681 1144 2204.576985 $146485.3700 $66.4500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 39 41 61.142857 $91714.3500 $1500.0000
AUD -HA_FUP AUDIOLOGY SERVICES 28 33 67.398415 $3369.9300 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 127 145 232.938094 $11646.9100 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 7 8 6.400000 $160.0000 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 96 114 260.509526 $13025.4900 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 27 31 61.252383 $1531.3100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 20 27 44.171430 $2208.5800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 3.066667 $76.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 76 85 165.961906 $8298.1100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 19 21 43.814287 $1095.3600 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 94 118 286.161911 $14308.1300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 24 29 64.176190 $1604.4000 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 4.714286 $117.8600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 43 53 439.285710 $10982.1600 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 11.714286 $585.7200 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 6 6 41.523809 $2076.1900 $50.0000
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 6 6 49.714285 $1242.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1234 1550 11739.936523 $586997.4000 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 9 10 84.419047 $4220.9600 $50.0000
INTR -INTR INTERPRETER 95 161 771.811903 $38590.6100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 41 49 381.500000 $25896.2300 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 1 1 3.214286 $174.6000 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 184 245 2089.947619 $141865.7400 $67.8800
PHY -97110HM PT SESSION BY PT ASST 8 9 92.714285 $5036.2500 $54.3200
SCONLY-SCONLY SERVICE COORDINATION ONLY 141 155 182.496825 $182.5000 $1.0000
SENS -FM FM RECEIVER HEARING AID 1 1 1.000000 $1650.0000 $1650.0000
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 7 9 15.000000 $7500.0000 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 8 11 14.459666 $939.8800 $65.0000
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 2 3 3.000000 $342.0000 $114.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 1 1 2.000000 $456.0000 $228.0000
SENS -V5264 EARMOLD 16 20 36.211110 $651.8000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 17 19 127.785714 $6389.3000 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 314 398 3104.442860 $210729.6700 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 14 14 156.714285 $2068.6300 $13.2000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 1555 2557 18031.931763 $9015.9600 $0.5000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 6 6 61.571430 $3078.5800 $50.0000
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Subtotal (Total Children Is Unduplicated) 1716 5939 38744.103358 $1209830.1100 $31.2300
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Total 7083 40948.680343 $1356315.4800 $33.1200
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Number of Children (Unduplicated) With at Least One Authorization 1787